A recent study published in Obstetrics & Gynecology shows that 655 women who sought emergency contraception and had a negative urine pregnancy test immediately before IUD placement did not become pregnant within a month’s time.
Neither the frequency nor the timing of unprotected sexual intercourse within two weeks of IUD placement impacted the outcome of the study.
Of the 655 women in the study, which was based in the United States, 286 women (43.7%) reported a median of three instances of unprotected intercourse in the fourteen days before IUD placement. 95 women (14.4%) reported a minimum of one instance of unprotected intercourse at six days or more before IUD placement. No pregnancies occurred in either of these categories (0.0% for both).
Women who reported unprotected intercourse within five days of IUD placement were shown to have a pregnancy risk of 0.2%.
No pregnancies were reported amongst women who had additional instances of unprotected intercourse at 6-7 days, 6-10 days, or 6-14 days before placement of the IUD (0% for all).
Review of Secondary Data
Researchers reviewed secondary data from a randomised trial of 655 women who sought emergency contraception via the copper T380A IUD or the levonorgestrel 52-mg intrauterine system between August 2016 and December 2019. The women were all between the ages of 18 and 35, and they were enrolled at one of six family planning clinics in the state of Utah.
In both the copper IUD and the levonorgestrel groups, which represented 68% and 74% of the women respectively, all the unprotected intercourse episodes took place in the five days of their fertile windows prior to the placement of the IUD.
The findings of the study were limited by several factors. Pregnancy rates by timing or frequency were unable to be analysed. As well, only patients from the state of Utah were included in the study. Researchers also noted that incidents of unprotected intercourse could have potentially been underreported.
Despite these limitations, the large sample size and the fact that the data represents unprotected intercourse before IUD placement in a randomised, controlled trial concerning two different IUDs makes the study meaningful to patient-centred family planning care.
The researchers pointed out that patients should be advised of the efficacy of IUD emergency contraception, especially in light of the uncertain data surrounding oral emergency contraception methods.
The Importance of Understanding Barriers to the Placement of IUDs
In a recent interview, Iris Krishna, MD, of Emory University in Atlanta, Georgia, asserted the importance of understanding barriers to the placement of IUDs and other forms of long-acting reversible contraception. She added that the risk of pregnancy with unprotected intercourse within 14 days of IUD placement is low and that multiple incidents of unprotected intercourse do not appear to increase the risk during this period of time. She encourages physicians to initiate and place long-acting reversible contraceptives in a single visit, acknowledging that little data around the efficacy of IUDs as an emergency contraceptive more than five days prior to placement is currently available.
Krishna also pointed out that the study suggests that pregnancy risk is similar between women who reported unprotected intercourse within five days prior to IUD placement and who reported unprotected intercourse within 14 days prior to IUD placement.
In terms of clinical practice, Krishna explained that the study gives clinicians more information with which to counsel patients concerned about the risk of pregnancy after IUD placement for the purpose of emergency contraception.
While highlighting the value of the information provided by this study, Krishna described a need for more studies that focus on the placement of IUDs in situations where episodes of unprotected intercourse have taken place more than 5 days prior to IUD placement. According to Krishna, these kinds of studies can help clinicians better understand the potential of IUDs as a form of emergency contraception and the time frames in which the IUD can be used as such. For Krishna, such information is necessary if the rates of unintended pregnancies in the United States are to go down.
This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the University of Utah Population Health Research Foundation, the National Center for Research Resources, and the National Center for Advancing Translational Sciences at the National Institutes of Health.
